Outcomes of Early Functional Endoscopic Sinus Surgery for Orbital Complications of Acute Rhinosinusitis

Background: Acute sinusitis affects millions of patients each year and is most often self-resolving or managed with antibiotics and/or steroid treatments with good resolution of symptoms. Though rare, complications of acute sinusitis can have serious consequences due to the proximity of numerous important anatomic structures. Extension of disease into the orbit is one such serious complication and can occur through direct extension or via shared venous connections. This can manifest as cranial nerve palsies, optic nerve involvement, and/or periorbital soft tissue inflammation, all of which can contribute to visual changes in the patient. If untreated, these sequelae can lead to significant morbidity including permanent visual impairment or loss. Because of this risk, rapid initiation of treatment is paramount for these patients. Currently, the mainstay of initial management is intravenous antibiotics; however, the utility of early surgical intervention has been poorly studied. This study aims to assess the orbital outcomes of functional endoscopic sinus surgery (FESS) and orbital decompression for patients with orbital complications of acute sinusitis and to evaluate the effect of prompt surgical intervention on visual outcomes.

Methods: An 8-year retrospective chart review was performed of patients who presented with subjective visual complaints in the setting of acute sinusitis and subsequently underwent FESS with orbital decompression and serial comprehensive ophthalmologic exams. Seven patient charts were identified and reviewed. Data from physical exam and ocular tests conducted by ophthalmology were collected from initial presentation and followed to symptom resolution or to the present.

Results: Seven patient charts met inclusion criteria. Average time from symptom onset to FESS was 7.6 days. Average time from tertiary hospital admission to FESS was 0.6 days. All seven patients had complete resolution of subjective visual complaints. Objective ocular exam findings including light reflex, visual acuity, intraocular pressures, and extraocular movements returned to baseline.

Conclusion: Prompt surgical intervention for orbital extension of rhinosinusitis is associated with positive outcomes and return to baseline orbital function. With orbital extension of rhinosinusitis, early surgical intervention should be considered in lieu of a watchful waiting approach with IV antibiotics.